Mortality patterns among recipients of autologous hematopoietic stem cell transplantation for lymphoma and myeloma in the past three decades

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Abstract

Background Understanding the mortality patterns of patients with lymphoma and myeloma, who have undergone autologous hematopoietic stem cell transplantation (ASCT) might identify improvement opportunities. Patients and Methods The present retrospective study included patients with lymphoma and myeloma, aged ≥ 18 years, who had undergone ASCT from 1983 to 2010 at the University of Nebraska Medical Center. Of the 2284 patients, 972 had died within first 5 years after ASCT. The patients were divided into 3 cohorts according to the time of transplantation: 1983 to 1990 (cohort I), 1991 to 2000 (cohort II), and 2001 to 2010 (cohort III). Using Cox proportional hazards regression analysis, the risk of cause-specific mortality was compared across the 3 cohorts. Results Of a total of 1215 deaths, 972 (80%) occurred within the first 5 years after ASCT. Disease relapse (73.4%), organ failure (7.8%), infection (4.7%), and secondary malignancy (4.2%) accounted for most of the deaths. The risk of death from infection (P <.0001), but not from relapse (P =.26), organ failure (P =.68), or secondary malignancy (P =.15), had declined in the more recent cohorts. Conclusion The 5-year overall survival of patients undergoing ASCT has improved significantly owing to a decline in infectious mortality. Our results highlight that the mortality from relapse remains the most common cause of death, warranting investigation of different strategies to reduce the incidence of relapse and improve the therapy for relapse after ASCT.

Original languageEnglish (US)
Pages (from-to)409-415.e1
JournalClinical Lymphoma, Myeloma and Leukemia
Volume15
Issue number7
DOIs
StatePublished - Jul 1 2015

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Hematopoietic Stem Cell Transplantation
Lymphoma
Mortality
Recurrence
Coinfection
Cause of Death
Neoplasms
Retrospective Studies
Transplantation
Regression Analysis
Survival
Incidence
Infection

Keywords

  • Autologous stem cell transplantation
  • Causes of death
  • Hodgkin lymphoma
  • Multiple myeloma
  • Non-Hodgkin lymphoma

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

@article{68fe5fc1cda849e69cb946c247b2ed24,
title = "Mortality patterns among recipients of autologous hematopoietic stem cell transplantation for lymphoma and myeloma in the past three decades",
abstract = "Background Understanding the mortality patterns of patients with lymphoma and myeloma, who have undergone autologous hematopoietic stem cell transplantation (ASCT) might identify improvement opportunities. Patients and Methods The present retrospective study included patients with lymphoma and myeloma, aged ≥ 18 years, who had undergone ASCT from 1983 to 2010 at the University of Nebraska Medical Center. Of the 2284 patients, 972 had died within first 5 years after ASCT. The patients were divided into 3 cohorts according to the time of transplantation: 1983 to 1990 (cohort I), 1991 to 2000 (cohort II), and 2001 to 2010 (cohort III). Using Cox proportional hazards regression analysis, the risk of cause-specific mortality was compared across the 3 cohorts. Results Of a total of 1215 deaths, 972 (80{\%}) occurred within the first 5 years after ASCT. Disease relapse (73.4{\%}), organ failure (7.8{\%}), infection (4.7{\%}), and secondary malignancy (4.2{\%}) accounted for most of the deaths. The risk of death from infection (P <.0001), but not from relapse (P =.26), organ failure (P =.68), or secondary malignancy (P =.15), had declined in the more recent cohorts. Conclusion The 5-year overall survival of patients undergoing ASCT has improved significantly owing to a decline in infectious mortality. Our results highlight that the mortality from relapse remains the most common cause of death, warranting investigation of different strategies to reduce the incidence of relapse and improve the therapy for relapse after ASCT.",
keywords = "Autologous stem cell transplantation, Causes of death, Hodgkin lymphoma, Multiple myeloma, Non-Hodgkin lymphoma",
author = "Bhatt, {Vijaya R} and Loberiza, {Fausto R.} and Hongmei Jing and Bociek, {Robert G} and Bierman, {Philip Jay} and Maness-Harris, {Lori J} and Vose, {Julie Marie} and Armitage, {James Olen} and Mojtaba Akhtari",
year = "2015",
month = "7",
day = "1",
doi = "10.1016/j.clml.2015.02.024",
language = "English (US)",
volume = "15",
pages = "409--415.e1",
journal = "Clinical Lymphoma, Myeloma and Leukemia",
issn = "2152-2669",
publisher = "Cancer Media Group",
number = "7",

}

TY - JOUR

T1 - Mortality patterns among recipients of autologous hematopoietic stem cell transplantation for lymphoma and myeloma in the past three decades

AU - Bhatt, Vijaya R

AU - Loberiza, Fausto R.

AU - Jing, Hongmei

AU - Bociek, Robert G

AU - Bierman, Philip Jay

AU - Maness-Harris, Lori J

AU - Vose, Julie Marie

AU - Armitage, James Olen

AU - Akhtari, Mojtaba

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background Understanding the mortality patterns of patients with lymphoma and myeloma, who have undergone autologous hematopoietic stem cell transplantation (ASCT) might identify improvement opportunities. Patients and Methods The present retrospective study included patients with lymphoma and myeloma, aged ≥ 18 years, who had undergone ASCT from 1983 to 2010 at the University of Nebraska Medical Center. Of the 2284 patients, 972 had died within first 5 years after ASCT. The patients were divided into 3 cohorts according to the time of transplantation: 1983 to 1990 (cohort I), 1991 to 2000 (cohort II), and 2001 to 2010 (cohort III). Using Cox proportional hazards regression analysis, the risk of cause-specific mortality was compared across the 3 cohorts. Results Of a total of 1215 deaths, 972 (80%) occurred within the first 5 years after ASCT. Disease relapse (73.4%), organ failure (7.8%), infection (4.7%), and secondary malignancy (4.2%) accounted for most of the deaths. The risk of death from infection (P <.0001), but not from relapse (P =.26), organ failure (P =.68), or secondary malignancy (P =.15), had declined in the more recent cohorts. Conclusion The 5-year overall survival of patients undergoing ASCT has improved significantly owing to a decline in infectious mortality. Our results highlight that the mortality from relapse remains the most common cause of death, warranting investigation of different strategies to reduce the incidence of relapse and improve the therapy for relapse after ASCT.

AB - Background Understanding the mortality patterns of patients with lymphoma and myeloma, who have undergone autologous hematopoietic stem cell transplantation (ASCT) might identify improvement opportunities. Patients and Methods The present retrospective study included patients with lymphoma and myeloma, aged ≥ 18 years, who had undergone ASCT from 1983 to 2010 at the University of Nebraska Medical Center. Of the 2284 patients, 972 had died within first 5 years after ASCT. The patients were divided into 3 cohorts according to the time of transplantation: 1983 to 1990 (cohort I), 1991 to 2000 (cohort II), and 2001 to 2010 (cohort III). Using Cox proportional hazards regression analysis, the risk of cause-specific mortality was compared across the 3 cohorts. Results Of a total of 1215 deaths, 972 (80%) occurred within the first 5 years after ASCT. Disease relapse (73.4%), organ failure (7.8%), infection (4.7%), and secondary malignancy (4.2%) accounted for most of the deaths. The risk of death from infection (P <.0001), but not from relapse (P =.26), organ failure (P =.68), or secondary malignancy (P =.15), had declined in the more recent cohorts. Conclusion The 5-year overall survival of patients undergoing ASCT has improved significantly owing to a decline in infectious mortality. Our results highlight that the mortality from relapse remains the most common cause of death, warranting investigation of different strategies to reduce the incidence of relapse and improve the therapy for relapse after ASCT.

KW - Autologous stem cell transplantation

KW - Causes of death

KW - Hodgkin lymphoma

KW - Multiple myeloma

KW - Non-Hodgkin lymphoma

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U2 - 10.1016/j.clml.2015.02.024

DO - 10.1016/j.clml.2015.02.024

M3 - Article

C2 - 25816932

AN - SCOPUS:84937512988

VL - 15

SP - 409-415.e1

JO - Clinical Lymphoma, Myeloma and Leukemia

JF - Clinical Lymphoma, Myeloma and Leukemia

SN - 2152-2669

IS - 7

ER -